Authorization Specialist - Bend, Oregon

Summit Health CityMD•Bend, OR

24d

About The Position

The Authorization Specialist obtains authorizations for surgical procedures, diagnostic testing, medications, durable medical equipment, outgoing referrals, and other services as part of the Revenue Cycle Department. The role requires understanding medical insurance and the clinical policies that govern authorization protocols for each health plan. The specialist monitors schedules, reports, and dashboards to identify appointments and procedures requiring authorization; verifies insurance eligibility and benefits; processes referrals and prior authorizations; and coordinates with patients, physicians, office staff, payers, and reimbursement teams to resolve issues and limit denials. The role also involves managing electronic work queues and patient account documentation, investigating denials and appeals, making daily inbound and outbound calls, maintaining patient confidentiality, and meeting department deadlines and benchmarks. This position requires a high school diploma or GED. A vocational or technical diploma and 2–4 years of related experience are preferred. Experience using standard office technology in a Windows-based environment and Microsoft Office Suite is required. The role may involve travel to satellite locations for meetings and includes physical requirements such as dexterity, agility, and endurance.

Requirements

High school graduate or GED required.
Experience using standard office technology in a Windows-based environment and Microsoft Office Suite required.
Ability to maintain patient confidentiality.
Physical agility to maneuver the body while in place.
Dexterity of hands and fingers.
Endurance for activities such as continuous typing, prolonged standing or bending, and walking.

Nice To Haves

Vocational or technical school diploma program preferred.
2–4 years of related experience preferred.
Experience with standard office equipment such as phone, fax, copy machine, scanner, and email or voicemail preferred.

Responsibilities

Identify appointments and procedures requiring authorization by monitoring schedules, system reports, and dashboards.
Determine referral and authorization requirements for patients’ insurance plans using online resources and department workflows.
Apply insurance carrier guidelines, clinical policies, and state guidelines related to referrals and prior authorizations.
Verify insurance eligibility and benefits, and update patient insurance information as needed.
Complete referrals and prior authorizations in a timely manner according to department guidelines and workflows.
Communicate with patients, physicians, office staff, and managers to resolve issues that could delay or result in denied authorization requests.
Use systems to run reports, document and manage referrals and authorizations, move correspondence, and resolve eligibility and authorization holds within assigned security access.
Request, prepare, and identify documentation needed to support medical necessity.
Provide supervisors and managers with prompt feedback about issues affecting workflow, reimbursement, and customer service.
Enter accurate information in patient accounts.
Collaborate with Reimbursement Department teams to limit denials and ensure proper reimbursement.
Work with team members to meet department deadlines and benchmarks.
Use available electronic tools and systems to organize and process daily work.
Anticipate and perform necessary duties while maintaining patient confidentiality.
Make daily inbound and outbound phone calls.
Select the correct insurance package in Epic and update authorizations and claims to reflect new insurance packages.
Sort work queues and reports to identify and process daily work, including schedules, inbound referral reports, and outgoing referrals.
Move correspondence from dashboards to patient accounts.
Communicate and document effectively with physicians, practice-location staff, peers, supervisors, managers, and payers.
Investigate authorization denials and appeals involving insurance and patients.